Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK.
Public Health England, London, UK.
Lancet. 2018 May 19;391(10134):2059-2070. doi: 10.1016/S0140-6736(18)30531-2. Epub 2018 Apr 5.
Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues.
政府可以利用财政政策来调节潜在不健康产品的价格和消费。然而,旨在通过提高价格来减少消费的政策,例如征税,可能会给低收入家庭带来不公平的经济负担。我们利用家庭支出调查数据,根据社会经济地位估算了潜在不健康产品的支出模式,主要关注的是低收入和中等收入国家。价格政策对更多高收入家庭的消费和支出产生影响,而不是低收入家庭,而且任何由此产生的价格上涨往往由高收入家庭不成比例地承担。然而,就占所有家庭消费的份额而言,价格上涨对低收入家庭的财务负担往往比高收入家庭更大,在烟草方面尤其如此,具体取决于价格上涨对消费的影响程度。由于低收入消费者对价格变化的强烈反应,他们往往会获得更大的健康效益。通过对所产生的税收进行有利于穷人的使用,可以减轻税收给低收入家庭带来的潜在更大的经济负担。